A Roadmap to Population Health Management
Numerof helped this recently merged health system define and move forward on a path to managing population health. In addition to modeling a new pricing structure and its implications, we provided actionable insight into issues causing $30M in annual losses within a single clinical area.
- In light of competitive threats, high cost, and declining reimbursement, this leading, recently merged regional health care system faced intense pressures to improve quality, reduce costs, and increase revenue.
- Additionally, system leadership recognized that maintaining a central focus on acute care was not sustainable in an increasingly outcomes-focused, risk-based environment.
- In light of these challenges, Numerof was asked to identify the elements required to successfully adopt a value-based care delivery model, conceptualize a roadmap for making the transition to population health management, and support implementation.
- Working with leadership, Numerof identified the cultural, technological, and infrastructure elements required to support adoption of a value-based care delivery model across the continuum of care. Organizational gaps were identified and specific recommendations for closing these gaps were defined.
- Using our proprietary framework for population health management, Numerof developed a macro-level roadmap defining specific implementation steps and guided the organization to select a pilot population for implementing a population health continuum of care model.
- Numerof evaluated the system’s current informatics and analytics capabilities (financial and clinical) essential to monitoring and managing variation in cost and quality – a key requirement for successful population health management.
- Using our proprietary analytics approach, Numerof evaluated patient-level clinical, financial, and quality data across the continuum of care to develop a preliminary population health pricing structure. Numerof also modeled the predicted future cost to treat, estimated risk associated with pricing options, and estimated the impact of this new pricing structure on profit margins.
- Numerof was also engaged to develop a value proposition and structure dialogues with key payers, independent provider organizations across the continuum, key external partners, and internal stakeholders to achieve alignment and buy-in for the new care delivery model.
- Strategies were created for organizational capability development and to secure affiliations with external partners.
- Specific interventions, associated metrics, and the relative ROI of each were defined.
- Numerof’s analyses and strategies have been used to engage payers in negotiations regarding new risk-based payment models.
- Proposed population health pricing strategies have allowed the organization to reverse historic losses in managing the target population and generate positive profit margins while improving its competitive position in the marketplace.
- The work brought new insight into the economics of care in this clinical area, identifying $30M in annual losses due to redundancy, forgone revenue, and system inefficiencies.
- Numerof was asked to support implementation of the roadmap across the system.
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